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Date; <br />Application For <br />PllBLIC WORKS PERMIT <br />Print or Type Cnly plan Ch.^.ck No: B 42660 SEPA <br />Applicat.Date: 11/10/93 <br />Job Address: 22b MADISON ST <br />Owner: WING DANIEL & KAREN <br />Tenant: <br />Ow.:=r Proposed Use: GARAGE/SFT2 <br />Desc. of Work: � <br />WEW POLE GARAGE <br />AppliCant <br />Des:ribe Proposed Work <br />Project Address (if known) <br />OFFICE SET' JOE SET <br />APPROVED FOR PERMIT: DATn_/_/__ BY <br />Zip <br />Zif: <br />Attach four (4) copies of plans for proposed work � Oraw to scale and note the tollowing as applicable: <br />• Property Lines <br />• Outline and dimensions of all existing and <br />proposed structures on the lot <br />• Exisling and proposed utilities <br />Pupllc WorNs Parmil � <br />eina. oeo��+ _ <br />Puelic WorMs Fee <br />Total Fee $ <br />Lass Aoo� Fee Faid S <br />Balanca �ua $ <br />i Centedine of street <br />• Indiwte North <br />• Show any proposed grading changes <br />• Show measurements <br />Phone <br />PERMIT CONDITIONS <br />1. All calis for inspection shall be made 24 hrs. in advance • phone 259•8810. <br />2. All work shall be pertormed in accordance with this permit and current City of Everett Design and Construction <br />Standards and Specificalions. <br />3. Call Location Underground Service 48 hrs. before you dig. TOLL FREE NUMBER 1-800•424•5555. <br />Approved for Construction <br />��UBllv^ WpF!<�. <br />NOT REOUI(�EdRM�T <br />BY /3 <br />DA7E , <br />s f��� <br />Date <br />FINAL INSPECTION Date <br />Approved as Construcled <br />���Iy� PUBLIC WORKS DEPARTMENT <br />32U0 Cedar Sireet <br />Everett, VJA 98207 <br />Phone:259�8810 <br />ACKNOWL[DGEMENT OF CONDITIOMS <br />W <br />I- <br />tl/ <br />� <br />O <br />■ <br />Y / <br />O <br />a <br />The untlersigned owner/applicant hereby agrees to hold and save harm- <br />less lhe Cily ol Everel� from any and all claims for damages, costs, <br />expenses, or causes of aclion �hat may arise because of inslallation <br />and maintenance of the improvement or other righFobway use hereto <br />applied lor and lurther agrees to remeve same upon notice Irom the <br />City a�d to replace public property damaged thereby. <br />Signature of Applicant Date <br />WORK AUTHORIZED BY THIS PEFMIT MUST 5E STARTED WITHIN <br />180 DAYS OF DATE PERMIT IS ISSUED ANC THEREAFTER IS TO <br />BE DI�IGENTLY PUFSUED TO COMPLETION. 7HIS PERMIT MAY BE <br />CANCELL�D BY THE CITY UPON ANY STOPPAGE O� WORK ON THIS <br />PROJECT OVER 90 DAYS DURATION. <br />